| NPI | 1770581126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 0417627) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO R8768) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2012-05-31 |