| NPI | 1295918696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 54636) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301089487) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2010-06-28 |