| NPI | 1619045028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101043500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0072534) |
| 208000000X Pediatrics (Licence: DC MD039283) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-11-23 |