| NPI | 1871621680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2015-02134) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: VT 0420009297) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2022-11-03 |