| NPI | 1972574796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2002001117) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 200200117) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-10-25 |