| NPI | 1558374371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 68235) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 056756) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-08-01 |