| NPI | 1265609929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-11412) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 6851459-1205) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2016-11-10 |