| NPI | 1255517660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 26618) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 236223) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2011-02-22 |