| NPI | 1609836774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 42780) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 200101005) |
| 208000000X Pediatrics (Licence: KY TP646) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2014-07-01 |