| NPI | 1134193642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2011021428) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 16852) |
| 208000000X Pediatrics (Licence: NC 2009-00528) | |
| 208000000X Pediatrics (Licence: GA 047463) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2011-09-07 |