| NPI | 1073757639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: MS 06405) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 12042) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2020-08-09 |