| NPI | 1760406755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C10004970) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD-063948-L) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |