| NPI | 1053311506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WY 7224a) |
| Additional Taxonomies | 174400000X Specialist (Licence: WY 7224A) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2013-02-25 |