| NPI | 1609066208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA MD-42227) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD064544L) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2015-01-14 |