| NPI | 1053793836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0060771) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 7589) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2024-02-19 |