| NPI | 1033135298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 48867) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301111066) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2016-10-27 |