| NPI | 1316155914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-5692) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 44151) |
| 208000000X Pediatrics (Licence: KY TP188) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2009-02-24 |