| NPI | 1033317870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA MD-43860) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 25311) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2020-02-11 |