| NPI | 1508919580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX m2580) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 044892) |
| 208000000X Pediatrics (Licence: IN 01061138A) | |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2008-11-25 |