| NPI | 1043370984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 116083) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO MOMD116083) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2017-10-30 |