| NPI | 1962525535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD42020) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD437975) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2023-03-07 |