| NPI | 1053521401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD42601) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 42601) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2014-03-10 |