| NPI | 1063036994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 1013772) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT221368) |
| Enumeration Date | 2020-06-06 |
| Last Update Date | 2023-06-20 |