| NPI | 1043836703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2023015522) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 8862) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2024-08-13 |