| NPI | 1235834870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2023023942) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11562) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2026-08-11 |