| NPI | 1407835879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2012003502) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 20720) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2016-03-18 |