| NPI | 1982689147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301047321) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FM 4301047321) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2021-01-13 |