| NPI | 1376720904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2008009981) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 001292) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2018-08-24 |