| NPI | 1578572087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 35764) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200101237) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2018-08-27 |