| NPI | 1306823448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA 27407) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 22112) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2012-09-17 |