| NPI | 1336115898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60232582) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 0420010398) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2011-11-10 |