| NPI | 1497117675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD213522) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 65708) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2022-12-14 |