| NPI | 1871976639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 37983) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 080335) |
| 208000000X Pediatrics (Licence: GA 7481) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2019-08-05 |