| NPI | 1629017249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MN 51280) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WY 6930A) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2016-01-15 |