| NPI | 1801860234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD0000029066) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 29066) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2010-11-01 |