| NPI | 1639120017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX J6184) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX J6184) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-07-13 |