| NPI | 1316945835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 0426765) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 103783) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2014-01-10 |