| NPI | 1720081557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD 11397) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101025181) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2009-09-16 |