| NPI | 1013198472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD.203209) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA PGY.1.TUL-PEDS) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2011-03-03 |