| NPI | 1700997103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA 018200) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA MD.018200) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-03-11 |