| NPI | 1326432600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2015031529) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-08617) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2021-12-17 |