| NPI | 1942397070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 51717) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD36528) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2016-04-28 |