| NPI | 1477636520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 6379) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI MD 6903) |
| 208000000X Pediatrics (Licence: CA G63020) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2013-05-14 |