| NPI | 1922178367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AZ 58728) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 162392) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2021-08-18 |