| NPI | 1710278841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2015014947) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-38060) |
| Enumeration Date | 2011-04-24 |
| Last Update Date | 2015-07-01 |