| NPI | 1871872465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 17322) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 3722R) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2023-05-02 |