| NPI | 1710197520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: GA 056716) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 056716) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-10-21 |