| NPI | 1841209327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MD059202L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD059202L) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-10-20 |