| NPI | 1356774137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0216X Pediatrics Pediatric Rheumatology (Licence: PA MT210378) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 257021) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2016-07-21 |