| NPI | 1326050725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2005-01936) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC SC28391) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-06-12 |