| NPI | 1467713370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101260758) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D79669) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2016-08-18 |