| NPI | 1831445733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301101010) |
| Additional Taxonomies | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: PA MT211597) |
| Enumeration Date | 2012-07-28 |
| Last Update Date | 2016-06-24 |