| NPI | 1871588632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-12411) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 23312) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2022-07-21 |