| NPI | 1487628905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N6380) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301078858) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2012-03-14 |