| NPI | 1902124100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-36610) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 54769) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2015-10-15 |