| NPI | 1194909846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 009687) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301087063) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2011-02-03 |