| NPI | 1629431028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301503322) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 312039) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2021-04-26 |