| NPI | 1245233303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 17098) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 17098) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: SC 17585) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2013-06-27 |