| NPI | 1487632246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 053436) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: GA 053436) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2007-07-08 |