| NPI | 1568578862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD038358) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101240007) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2010-08-20 |