| NPI | 1033156245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 200600501) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2006-00501) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2015-11-11 |