| NPI | 1093158388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q7837) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10047231) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2020-09-23 |