| NPI | 1326019373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101237021) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2023-01920) |
| Enumeration Date | 2006-01-29 |
| Last Update Date | 2023-10-30 |