| NPI | 1972872950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 137925) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 04386) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2011-12-21 |