| NPI | 1063449049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E10930) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 112085) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2018-03-22 |