| NPI | 1275710444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI H2810) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: HI H2810) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2008-01-30 |