| NPI | 1982831210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 54831) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-8721) |
| Enumeration Date | 2009-06-13 |
| Last Update Date | 2012-08-09 |