| NPI | 1467587022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME27218) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35040498) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-08 |