| NPI | 1558574475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 25659-020) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 146690-1) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2013-02-27 |