| NPI | 1215597315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 67734) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 30243) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2024-02-22 |