| NPI | 1801902143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 65179) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 075099) |
| 208000000X Pediatrics (Licence: PR 14923) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2022-12-16 |