| NPI | 1023005535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD35723) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS MD18396) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2007-07-08 |