| NPI | 1962490664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 13968) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 023570) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2012-12-10 |