| NPI | 1366761678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0010302) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D0010302) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2012-07-10 |