| NPI | 1124132717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO R3B31) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 0419525) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2014-06-24 |