| NPI | 1760442321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME61516) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101038822) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2013-07-30 |