| NPI | 1407064124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 46544) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116016848) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2012-04-25 |