| NPI | 1326545161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR DO215051) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK OK7475) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2023-10-04 |