| NPI | 1770801748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 83351) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2013-00520) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2021-05-20 |