| NPI | 1952563611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY TP415) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 002969) |
| 208000000X Pediatrics (Licence: TN 47695) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2021-03-26 |