| NPI | 1174013932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0102206530) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL51961) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2022-08-18 |