| NPI | 1750325148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2010-00075) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101239869) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2012-12-10 |