| NPI | 1619020468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD021198) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD21198) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2014-06-10 |