| NPI | 1851388516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 107648) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 0426309) |
| Enumeration Date | 2005-09-28 |
| Last Update Date | 2014-09-11 |