| NPI | 1770768541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 062439) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 002116) |
| Enumeration Date | 2007-12-29 |
| Last Update Date | 2018-06-05 |