| NPI | 1902827751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 67845) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD000000L) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2016-03-10 |