| NPI | 1730345950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 1027) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2008017176) |
| 208000000X Pediatrics (Licence: MN 55124) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2013-04-26 |