| NPI | 1619191939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2009-01503) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD.12254R) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2014-07-17 |