| NPI | 1194710632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101263142) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 9801733) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2017-11-09 |