| NPI | 1033886593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME164780) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: FL TRN34193) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2024-09-16 |