| NPI | 1346653722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR 184207) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116026909) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-07-21 |