| NPI | 1154591907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MD D73680) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D73680) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2012-04-10 |