| NPI | 1275616526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D63209) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD33125) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-03-07 |