| NPI | 1548238439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 16311) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 16311) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-03-05 |