| NPI | 1942681333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA DO-05159) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-10371) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2018-06-15 |