| NPI | 1306808829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-9613) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 33347) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2016-09-23 |