| NPI | 1255863403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 69030) |
| Additional Taxonomies | 2080H0002X Pediatrics, Hospice and Palliative Medicine (Licence: MN 69030) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-02-18 |