| NPI | 1306007083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA 4113) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-8414) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2011-06-15 |