| NPI | 1023645215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2023-02562) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 260897) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2023-08-28 |