| NPI | 1306424379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2021022124) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10626) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2021-06-30 |