| NPI | 1265427330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C1-0008267) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WA MD00019734) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2009-02-18 |