| NPI | 1144022112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2025018727) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-12395) |
| Enumeration Date | 2025-03-27 |
| Last Update Date | 2025-06-23 |