| NPI | 1821298522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2014-01643) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC TL29878) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2020-10-25 |