| NPI | 1962482133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0113438) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AL 29086) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: GA 030140) | |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2018-05-16 |