| NPI | 1982917894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A90174) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101244152) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2011-02-25 |