| NPI | 1285627729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR50095) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD24361) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2013-01-23 |