| NPI | 1619944410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301079415) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 10484) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2017-12-26 |