| NPI | 1720255128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WY 8169A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 229430) |
| 208000000X Pediatrics (Licence: ID M-10596) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2009-07-02 |