| NPI | 1881028082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 78294) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL36867) |
| Enumeration Date | 2013-08-25 |
| Last Update Date | 2020-01-09 |