| NPI | 1225232721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101241899) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 272928) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2020-11-10 |