| NPI | 1881623239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0038882) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT 36139) |
| 208000000X Pediatrics (Licence: NC 2016-01869) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2024-02-19 |