| NPI | 1861467847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101256805) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD073280L) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2020-11-10 |