| NPI | 1568572733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 28797) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 1042652) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-03-12 |