| NPI | 1598085003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 19983) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT MED-PHYS-LIC-34868) |
| 208000000X Pediatrics (Licence: DC MD041734) | |
| 208000000X Pediatrics (Licence: MD D0076485) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2021-07-29 |