| NPI | 1013204296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2015040888) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 0437804) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2016-01-14 |