| NPI | 1679534762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 018708) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: GA 018708) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2016-03-18 |