| NPI | 1700174000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS12891) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101019501) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2016-01-28 |