| NPI | 1962518191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX H5589) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX H5589) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2015-12-22 |