| NPI | 1104990027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 22605) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01040820A) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2013-06-25 |