| NPI | 1811429145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD469264) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT213507) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2020-07-20 |