| NPI | 1346225190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX F3348) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AR E-5207) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: WI 36224-020) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-05-04 |