| NPI | 1679607287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301087701) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SD 7851) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2012-11-27 |