| NPI | 1497742753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2006-01715) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN md29175) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2012-02-09 |