| NPI | 1477832632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 15191) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 261762) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2011-08-05 |