| NPI | 1255330759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101239590) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0068004) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2012-04-19 |