| NPI | 1356334312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD0717) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS MD11973) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2007-07-08 |