| NPI | 1821400029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61521956) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C7-0006657) |
| 208000000X Pediatrics (Licence: PA MT213601) | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2024-12-19 |