| NPI | 1821021866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-41456) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 48853) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2019-05-13 |