| NPI | 1124129689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 5101006719) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MO 34345) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-05-30 |