| NPI | 1871860676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR DO192829) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102203779) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2021-03-25 |