| NPI | 1720286271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 0435150) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011021435) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2011-07-21 |