| NPI | 1285617928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 248724-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO 40502) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2013-07-26 |