| NPI | 1972775039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 687716) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 064258) |
| 208000000X Pediatrics (Licence: GA 002538) | |
| Enumeration Date | 2008-03-29 |
| Last Update Date | 2021-07-29 |