| NPI | 1093779654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 04740R) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA 04740R) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2021-04-08 |