| NPI | 1053578427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 063038) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 247799) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2009-12-04 |