| NPI | 1306885496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 78368) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 032413) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-02-07 |