| NPI | 1558361469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME91394) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 045690) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-09-06 |