| NPI | 1508936949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 112541) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 057100) |
| 208000000X Pediatrics (Licence: GA 057100) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2013-06-18 |