| NPI | 1043472632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 26040) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 5915) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2013-02-19 |