| NPI | 1477799138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD036889) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G24599) |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2008-12-31 |