| NPI | 1073958724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: LA 311379) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 191556) |
| 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: OH 128028) | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2019-05-30 |