| NPI | 1891177879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 70430) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2015017212) |
| 208000000X Pediatrics (Licence: NE 1828) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2022-05-06 |