| NPI | 1366881187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 29196) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 6987) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2016-07-12 |