| NPI | 1679567085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD12816) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD121816) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2008-04-23 |