| NPI | 1750676235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 61764) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101252354) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2019-10-29 |