| NPI | 1760005573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A193299) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101275024) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2024-06-12 |