| NPI | 1972591741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 205734) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL MD.26832) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2017-01-25 |