| NPI | 1487675153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 36321) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 18670) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2009-07-21 |