| NPI | 1164710026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-39743) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2015011039) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2022-07-21 |