| NPI | 1568413599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2012035054) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-37538) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2015-08-17 |