| NPI | 1154633410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD448015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT197033) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2013-04-19 |