| NPI | 1629116041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 40918-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 0119137) |
| 208000000X Pediatrics (Licence: MI 4301407222) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-10-09 |