| NPI | 1790913200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2012-0606) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM RS2009-0280) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2024-09-11 |