| NPI | 1902940570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-9876) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 6027170-1205) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2016-11-10 |