| NPI | 1245613082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101272247) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS T-3719) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2023-04-06 |