| NPI | 1568461622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME46189) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL me46189) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2021-06-18 |