| NPI | 1750365409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV DO1575) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR DO14538) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2014-04-17 |