| NPI | 1528095585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301032178) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 37258-020) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2013-07-31 |