| NPI | 1972596567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 18038) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS 18038) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2018-09-05 |