| NPI | 1063401594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301074387) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101232756) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2016-08-19 |