| NPI | 1770545931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 3227931205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 3227938905) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2011-10-10 |