| NPI | 1639175789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD0556631L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD055663L) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2009-10-07 |