| NPI | 1982854840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI L2357554) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 234056) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2015-05-01 |