| NPI | 1750504213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 010090) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 10090) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2016-09-14 |