| NPI | 1104860386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 15101) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME98045) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2013-11-06 |