| NPI | 1902098486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 50153-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 24286) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2022-08-09 |