| NPI | 1760790448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS15375) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102203309) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2018-09-07 |