| NPI | 1669521332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00026233) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01034261A) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |