| NPI | 1669630240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: WA 60096072) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD434570) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2013-07-30 |