| NPI | 1467418277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD014151) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA LA014151) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2015-02-03 |