| NPI | 1932413259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 83531) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 25331) |
| 208000000X Pediatrics (Licence: WI 56601) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2021-01-26 |