| NPI | 1285636597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 0429365) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 62040) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2017-07-17 |