| NPI | 1003815291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2008032320) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 2101) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2017-02-23 |