| NPI | 1760447858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 200200724) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200200724) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2011-03-21 |