| NPI | 1962450189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX J6832) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T3097) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-04-20 |