| NPI | 1386672822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD26093) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD26093) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2013-04-11 |