| NPI | 1366785438 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 17540) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17540) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2013-04-04 |