| NPI | 1225234834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ACN1259) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 15290) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2023-01-31 |