| NPI | 1538432018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2020-02658) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102204044) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2020-08-20 |