| NPI | 1538242995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PR 6234) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 6234) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2015-12-04 |