| NPI | 1023597218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.00713041) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 33623-R) |
| 208000000X Pediatrics (Licence: VA 0101272460) | |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2023-08-29 |