| NPI | 1518025717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA 15281) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 7414) |
| 208000000X Pediatrics (Licence: WI 17937020) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-08-21 |