| NPI | 1821155532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 20235) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01041832A) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-09 |