| NPI | 1740546324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD043256) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101258343) |
| Enumeration Date | 2012-04-08 |
| Last Update Date | 2015-11-19 |