| NPI | 1780908574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 10105612-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD449879) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2019-12-31 |