| NPI | 1982799763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2009016967) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-7924) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-09-19 |