| NPI | 1932125804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD-012005) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD.012005) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2025-04-30 |