| NPI | 1821120650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC MD26941) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 26941) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2019-08-15 |