| NPI | 1821135070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-15451) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2002007691) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2022-07-25 |