| NPI | 1558366427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD458449) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 041485) |
| 208000000X Pediatrics (Licence: DE C10010179) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2016-09-08 |