| NPI | 1306322292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR0074979) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD484101) |
| Enumeration Date | 2018-07-14 |
| Last Update Date | 2025-06-10 |