| NPI | 1013902709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2015022188) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-38278) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2015-08-25 |