| NPI | 1265491526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 26427) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101246204) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2009-12-14 |