| NPI | 1275730236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60217580) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT190264) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2012-01-24 |