| NPI | 1477502607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AL 00006213) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AL 0006213) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2011-04-15 |