| NPI | 1790786515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-13125) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 200901147) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2022-07-21 |