| NPI | 1700988136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME80932) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME008932) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2023-01-04 |