| NPI | 1962587287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 38147) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101030878) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2012-12-17 |