| NPI | 1225695919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 88254) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL82228) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2022-08-15 |