| NPI | 1831140672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 44025-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 31832) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2024-01-18 |