| NPI | 1508031873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 65993) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-8273) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2012-09-13 |