| NPI | 1114090008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD-14643) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME91851) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2008-10-09 |