| NPI | 1871501684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MD042906E) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD042906E) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2013-04-15 |