| NPI | 1275791253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 204482) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 253214) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2012-09-24 |