| NPI | 1205930302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 18878) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CO 18878) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2010-07-21 |