| NPI | 1538329008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 253279) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 253279) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2012-08-31 |