| NPI | 1235302662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2006016543) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-33900) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2017-09-25 |