| NPI | 1053763862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301110650) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 4125) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2024-06-21 |