| NPI | 1326243593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 61916) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-8100) |
| 208000000X Pediatrics (Licence: IA 39186) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2014-04-28 |