| NPI | 1053512814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME148954) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125050775) |
| 208000000X Pediatrics (Licence: IA MD-42748) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2024-12-18 |