| NPI | 1053817130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0095745) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101272368) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2024-03-22 |