| NPI | 1811151871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD158109) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011016081) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2020-04-22 |