| NPI | 1639240062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0031385) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD23838) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2017-02-17 |