| NPI | 1538125539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 0428220) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 110921) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2016-04-15 |