| NPI | 1043215833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 32048) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 32048) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2012-11-21 |