| NPI | 1699059634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 17587) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 18078) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2011-10-10 |