| NPI | 1912956004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NM MD2008-0573) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 016372) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2009-01-30 |