| NPI | 1932386711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 7664629-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2007017356) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2021-03-30 |