| NPI | 1184922163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD.03817R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL MD.7555) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2011-03-01 |