| NPI | 1831410810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 34954) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 27784) |
| 208000000X Pediatrics (Licence: TN 50004) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2016-12-15 |