| NPI | 1023194867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 10207) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 016299) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2018-03-17 |