| NPI | 1083640643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ND 7224) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 46225) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2011-10-12 |