| NPI | 1811316227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 64507) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2017-0819) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2022-03-24 |