| NPI | 1689681884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 20144) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 0414742) |
| 208000000X Pediatrics (Licence: WI 19438) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |