| NPI | 1336300052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD442322) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA mt192992) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2011-07-06 |