| NPI | 1881662633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 20078) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 20078) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2014-10-23 |