| NPI | 1922065713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME11223) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VI 1094) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2014-04-28 |