| NPI | 1699756627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0072015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101059012) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2014-02-24 |