| NPI | 1649220260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D57905) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D57905) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2012-12-28 |