| NPI | 1528191202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VT 0600003161) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT 11403) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2012-11-13 |