| NPI | 1477648012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 025790) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 28497) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-02-17 |