| NPI | 1902054885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI 16732) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 205867) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2016-04-28 |