| NPI | 1346776523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 26753) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WI 26753) |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2017-05-07 |