| NPI | 1346265097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD05137R) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA MD05137R) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |