| NPI | 1891712220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MD055065L) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 34630) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2021-01-08 |