| NPI | 1306004577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA 442544) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 232262) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2012-10-30 |