| NPI | 1912453861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A185931) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 28771) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-09-13 |