| NPI | 1689635161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 042511) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01046250) |
| 208000000X Pediatrics (Licence: FL ME74728) | |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2007-07-08 |