| NPI | 1790758415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0216X Pediatrics, Pediatric Rheumatology (Licence: IA 40231) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD419015) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2012-06-27 |