| NPI | 1841431640 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD041643) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D746406) | 
| Enumeration Date | 2009-03-09 | 
| Last Update Date | 2013-09-05 |