| NPI | 1215157078 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0216X Pediatrics, Pediatric Rheumatology (Licence: PA MD4244582)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD4244582)  | 
| Enumeration Date | 2007-04-26 | 
| Last Update Date | 2013-04-15 |