| NPI | 1508823592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 66583-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 17708) |
| 208000000X Pediatrics (Licence: IN 01043200A) | |
| 208000000X Pediatrics (Licence: VT 042.0013318) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2017-08-07 |