| NPI | 1255311361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA 3772) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI DO00617) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2009-07-23 |