| NPI | 1215223649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2013035552) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-37231) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2015-11-17 |