| NPI | 1790008803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 19639) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 07899) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2023-08-14 |