| NPI | 1295973683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD4030) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 16995) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-01-23 |