| NPI | 1851391999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2008-00766) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 050320) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2021-05-11 |