| NPI | 1760578918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D36230) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D36230) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2013-03-04 |