| NPI | 1720184971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WY 2242-A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID M-8166) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-09 |