| NPI | 1871552315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 35046) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200200516) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2019-02-20 |