| NPI | 1679689798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME97632) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 16316) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2012-02-14 |