| NPI | 1861454894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 057067) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 45529) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2022-01-13 |