| NPI | 1720045982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD071463L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 062000) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2012-08-02 |