| NPI | 1659427813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D68668) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD P21308) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2009-11-02 |