| NPI | 1922163534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 1609951205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 1609958905) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |