| NPI | 1801989611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 23947) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60622294) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-03-08 |