| NPI | 1669411161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 72542) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 3193271205) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2009-08-06 |