| NPI | 1730440058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 78003) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD189218) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2019-09-19 |