| NPI | 1013468974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 281PC2000X Chronic Disease Hospital Children (Licence: PR 8537) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital Children (Licence: PR 8537) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2016-10-17 |