| NPI | 1679553010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MI 4301062068) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301062068) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2013-11-15 |