| NPI | 1134192180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI 15284) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD09330) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2010-03-10 |