| NPI | 1134121585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS5015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 085015) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2008-11-10 |