| NPI | 1992169239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD046956) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101270711) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2020-11-13 |