| NPI | 1700802634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ND 5340) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ND 9323) |
| 208000000X Pediatrics (Licence: MN 45703) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2012-04-18 |