| NPI | 1922198753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2007-00317) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301088908) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2011-09-28 |