| NPI | 1932175015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME137399) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 039780) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-03-10 |