| NPI | 1760844898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2016021987) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-09121) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2016-08-10 |