| NPI | 1346201951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD455129) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 40379) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2016-06-09 |