| NPI | 1720186513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 22408) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 22408) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-06-19 |