| NPI | 1043290695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 200000996) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 33115) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2016-03-25 |