| NPI | 1609015965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD15043) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: HI MD15043) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2009-02-10 |