| NPI | 1427540178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS21488) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OS021622) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2025-01-09 |