| NPI | 1114992856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 61457178905) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-29652) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2008-02-04 |