| NPI | 1518982594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 95037) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX L 9813) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2010-10-06 |