| NPI | 1336762947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA MD-51751) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-11807) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2023-08-17 |