| NPI | 1174659916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 0051877) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA L-221692) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2013-01-15 |