| NPI | 1467412791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 051116) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 3085901-1205) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2016-10-17 |