| NPI | 1356637763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA DO-4496) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-9235) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2014-10-13 |