| NPI | 1134119571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-38735) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD051853) |
| 208000000X Pediatrics (Licence: CO DR.0055577) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2016-10-19 |