| NPI | 1619078615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD4255) |
| Additional Taxonomies | 2080P0214X Pediatrics Pediatric Pulmonology (Licence: HI MD4255) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |