| NPI | 1871589374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD068203L) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PA MD068203L) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-10-31 |