| NPI | 1376759860 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: PR 14353) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 14353) | 
| Enumeration Date | 2007-05-14 | 
| Last Update Date | 2016-08-24 |