| NPI | 1124555222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 04992) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2020-01884) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2022-10-06 |