| NPI | 1407138985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 34675) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0041845) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2011-09-12 |