| NPI | 1780850008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 64807) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME115859) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2015-11-05 |