| NPI | 1922484112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 44318) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A155073) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2024-11-01 |