| NPI | 1609857937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2015-00879) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR C6587) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2015-09-21 |