| NPI | 1073510608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME109698) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD073400L) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2013-02-28 |