| NPI | 1811951825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 43726) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD423080) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2016-10-11 |