| NPI | 1891225694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD470118) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT212742) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2022-07-21 |