| NPI | 1659357523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101038914) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: VA 0101038914) |
| 208D00000X General Practice (Licence: VA 0101038914) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2016-03-16 |