| NPI | 1932594926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NE 1576) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 1576) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2021-09-10 |