| NPI | 1376536789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2006-01965) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD067652L) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2016-07-28 |