| NPI | 1336116185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 0528735) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 112944) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2007-07-08 |