| NPI | 1568446821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA 018210) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 018210) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2014-10-14 |