| NPI | 1326063587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0059573) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD32764) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-09 |