| NPI | 1093177073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: VA 0101263112) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A162777) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2023-08-28 |