| NPI | 1922678325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4351048177) |
| Additional Taxonomies | 2080C0008X Pediatrics, Child Abuse Pediatrics |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2024-06-06 |