| NPI | 1710094826 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 20449) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301037445) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |