| NPI | 1306282785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2025023110) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 9408066) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2025-06-19 |