| NPI | 1992715130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME163346) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 64973) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2023-11-20 |