| NPI | 1982970968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 309724) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 61490-20) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2023-05-24 |