| NPI | 1215974126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E1002) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA MD-42223) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-07-28 |