| NPI | 1518912864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD.205169) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME87347) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2012-10-25 |