| NPI | 1740387844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS10247) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT 11145) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-02-07 |