| NPI | 1710976337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 50097) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID M7658) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2015-03-10 |