| NPI | 1760514145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60023236) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 220483) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2009-12-28 |