| NPI | 1184824856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D74404) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME98752) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2015-12-20 |