| NPI | 1184647836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-35406) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011023185) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-12-21 |