| NPI | 1811152044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2011012289) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 20080117891) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2011-08-05 |