| NPI | 1558417287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D13695) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD04578) |
| 208000000X Pediatrics (Licence: VA 010122081) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |