| NPI | 1013397025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA 1013397025) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT208697) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2017-06-07 |