| NPI | 1912199936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME109755) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 001739) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2014-05-14 |