| NPI | 1073006755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-14594) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 010077) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-07-23 |