| NPI | 1205964624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 111906) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-36170) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2013-05-15 |