| NPI | 1689847485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WY 8120A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2008005511) |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2015-11-24 |