| NPI | 1801900485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 27623) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 0419120) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2009-06-17 |