| NPI | 1508123852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2018016657) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD043173) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2022-01-13 |