| NPI | 1740449396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2011-0534) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ND 11251) |
| Enumeration Date | 2008-06-07 |
| Last Update Date | 2011-09-13 |