| NPI | 1730345323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2011020098) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 50147) |
| 208000000X Pediatrics (Licence: MI L1320199) | |
| Enumeration Date | 2008-08-02 |
| Last Update Date | 2020-09-18 |