| NPI | 1083893507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX BP10069) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101242697) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2021-10-04 |