| NPI | 1285697862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD19865) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR 19865) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2008-04-23 |