| NPI | 1386769065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 254048) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL me97669) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2009-07-27 |