| NPI | 1801041157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 25191) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101032803) |
| Enumeration Date | 2008-11-28 |
| Last Update Date | 2008-11-28 |