| NPI | 1518497247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 67606) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101270353) |
| 208000000X Pediatrics (Licence: VA 0116030336) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2021-07-01 |