| NPI | 1679869101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 47268) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 069569) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2014-07-24 |