| NPI | 1356846372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0066756) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WY 14020A) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2023-07-13 |