| NPI | 1760481576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2007-01181) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 18196) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2021-08-19 |