| NPI | 1154646784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 077228) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2014-0536) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2022-11-01 |