| NPI | 1780627596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 45699) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME82100) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2017-01-18 |