| NPI | 1811080013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD417522) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 289808) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-03-30 |