| NPI | 1033111570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 17958) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 17958) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2018-12-05 |