| NPI | 1790166726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC LL37687) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102205143) |
| 208000000X Pediatrics (Licence: OH 34.014111) | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2022-08-29 |