| NPI | 1760615710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 26089) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125055068) |
| 208000000X Pediatrics (Licence: GA 66329) | |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2022-11-08 |