| NPI | 1265497812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 62300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME90190) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2013-02-14 |