| NPI | 1306989306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E9015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 112518) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2018-01-31 |