| NPI | 1902886773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME64875) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 26493) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2017-04-12 |