| NPI | 1861454480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: PA OS004416L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OS004416L) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2021-07-21 |