| NPI | 1699760629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 10534932-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD417392) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2022-08-31 |