| NPI | 1548461114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 65318) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN11022) |
| 208000000X Pediatrics (Licence: FL ME106793) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2011-03-23 |