| NPI | 1932633625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101270986) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0089597) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2022-03-04 |