| NPI | 1972796225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C1-0008424) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD446913) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2014-08-17 |