| NPI | 1184003345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2018011352) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-44522) |
| 208000000X Pediatrics (Licence: MI 4301107517) | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2021-07-08 |