| NPI | 1003336595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301502041) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301112413) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-08-15 |