| NPI | 1598760597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101025624) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D17986) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2016-01-09 |