| NPI | 1720013493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 00252) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: SC 00252) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-07-08 |