| NPI | 1982691465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD3423) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS MD16953) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2007-07-08 |