| NPI | 1922116789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA 32010) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 20636) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2013-12-16 |