| NPI | 1184882839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD442576) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 238707) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2013-04-18 |