| NPI | 1811126469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019033201) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101249404) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2021-01-18 |