| NPI | 1265530224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2013032858) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 3349) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-02-12 |