| NPI | 1750353116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE NV9118) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 9118) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2023-04-10 |