| NPI | 1194793976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME117593) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-108401) |
| 208000000X Pediatrics (Licence: CA C53816) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2014-03-17 |