| NPI | 1215157417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 29358) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 001206) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2015-07-29 |