| NPI | 1528473469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 86509) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2017-01215) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2022-04-22 |