| NPI | 1982687398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR L3945) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 13945) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2012-10-16 |