| NPI | 1902810260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ AZ22558) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX F4484) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2019-07-23 |