| NPI | 1992098214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 58469) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101256226) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2021-09-07 |