| NPI | 1588756100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS4666) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL OS4666) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-07-30 |