| NPI | 1083078950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019025548) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-42335) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2020-06-08 |