| NPI | 1497718514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 14809) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: CT 14809) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2007-07-13 |