| NPI | 1174590673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 55823) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 030712) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2007-07-08 |