| NPI | 1245459551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0216X Pediatrics, Pediatric Rheumatology (Licence: TX Q3876) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57010161) |
| 208000000X Pediatrics (Licence: PA MD435796) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2015-05-29 |