| NPI | 1215466347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA AP61400664) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 53-80169-112) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2023-04-21 |