| NPI | 1215103171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61491409) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 6353386-1205) |
| 208000000X Pediatrics (Licence: IL 036120274) | |
| 208000000X Pediatrics (Licence: ID M11886) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2024-09-26 |