| NPI | 1992440143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 8962266-1204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R3764) |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2025-06-30 |