| NPI | 1740635747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS15964) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 82123) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2023-08-03 |