| NPI | 1245617406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61301644) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-42074) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2022-09-16 |