| NPI | 1912327768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0083689) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 101263440) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2021-06-10 |