| NPI | 1104250570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MD 37179) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD 37179) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2013-08-21 |