| NPI | 1801888334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ND 10709) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD044634E) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2019-03-01 |