| NPI | 1174567580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 18418) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2007-00180) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2014-08-11 |