| NPI | 1932153558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: WA MD60275075) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: VA 0101053551) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-05-11 |