| NPI | 1669793378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 255331) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 245513) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2013-11-04 |