| NPI | 1821132580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD0000044551) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 057124) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2009-04-13 |