| NPI | 1083357800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022015275) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10972) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2022-08-30 |