| NPI | 1578131553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX V1194) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10077021) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-06-28 |