| NPI | 1770582561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 02660) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 02660) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2024-01-05 |