| NPI | 1063496594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: NY 264373) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 35271) |
| 2080P0210X Pediatrics, Pediatric Nephrology (Licence: KY 35271) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2014-09-02 |