| NPI | 1629031133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101048788) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 048788) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2009-11-20 |