| NPI | 1376672311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 73672) |
| Additional Taxonomies | 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: MA 73672) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2014-04-23 |