| NPI | 1265434096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A92271) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GU M-1777) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2017-03-01 |