| NPI | 1841234366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 22190) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 60267766) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-11-03 |