| NPI | 1811990625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 163136) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 33911) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2021-05-07 |