| NPI | 1902876626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101229312) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 49488) |
| 208000000X Pediatrics (Licence: CT 050867) | |
| 208000000X Pediatrics (Licence: NY 265453) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-06-27 |