| NPI | 1619968922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301067273) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MI 4301067273) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2014-02-05 |