| NPI | 1801862412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT 7761) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AK 143824) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2020-01-28 |