| NPI | 1467948976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 21955) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61300346) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2024-07-25 |