| NPI | 1164438396 |
|---|---|
| Other Name | NA NA NA |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04 36867) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2003014165) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2014-03-20 |