| NPI | 1710950548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2010-01364) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 39507) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2010-10-14 |