| NPI | 1609884147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SD 7382) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD19680) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2011-12-06 |