| NPI | 1952680639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL DO.2974) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX p8647) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2022-08-25 |