| NPI | 1104964345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D14029) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD5810) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-07-08 |