| NPI | 1457354391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A49005) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 28727) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2011-01-06 |