| NPI | 1346709664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD210709) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61333070) |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2023-05-17 |