| NPI | 1609061605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0102202385) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA OP 60370839) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2014-03-05 |