| NPI | 1508849225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 062014) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200201212) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2012-02-23 |