| NPI | 1215934039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 105957) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 05-26244) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2014-07-31 |