| NPI | 1285679068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS MS12443) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN TN01000013260) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-07-08 |