| NPI | 1780602326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2014-00724) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 42874) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-10-11 |