| NPI | 1548366172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA MD32239) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 36551) |
| 208000000X Pediatrics (Licence: GA 81885) | |
| 208000000X Pediatrics (Licence: OH 35.135284) | |
| 208000000X Pediatrics (Licence: LA MD.022290) | |
| 208000000X Pediatrics (Licence: HI MD-13260) | |
| 208000000X Pediatrics (Licence: WA MD00045787) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2022-05-31 |