| NPI | 1164827762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101260176) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0092938) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2023-04-11 |