| NPI | 1952860025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MT228883) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T5392) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2023-06-24 |