| NPI | 1407919954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 49195) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT 10975) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2016-07-06 |