| NPI | 1417070673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD437323) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT188521) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-08-31 |