| NPI | 1184044877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: UT 9601925-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 9601925-1205) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2021-10-20 |