| NPI | 1881638146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 45085) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 41492-020) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2021-06-12 |