| NPI | 1386628907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 28313) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: GA 025091) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2023-09-14 |