| NPI | 1801065800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD-14817) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A100319) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-07-28 |