| NPI | 1790724433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 034721) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME89382) |
| 208000000X Pediatrics (Licence: MS 18853) | |
| 208000000X Pediatrics (Licence: SC 27667) | |
| 208000000X Pediatrics | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |