| NPI | 1487810958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD442305) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT192568) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2013-05-22 |