| NPI | 1578749644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2006024353) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2006024353) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2008-07-01 |