| NPI | 1780905083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60747018) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 245512) |
| 208000000X Pediatrics (Licence: UT 8692257-1205) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2020-10-28 |