| NPI | 1588624597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CT 022569) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 22569) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2013-09-20 |