| NPI | 1083119077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2018018683) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-09696) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2018-12-28 |