| NPI | 1790805273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 250514) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD049395) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2024-11-29 |