| NPI | 1558405498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2013-01505) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 046134) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2015-01-13 |