| NPI | 1760683585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NE 24022) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 24022) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: SD SD9881) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2023-11-28 |