| NPI | 1467575506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 235131) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 225867) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2012-03-19 |