| NPI | 1033421722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 84834191204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ r1818) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2023-03-07 |