| NPI | 1376179275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD-23325-0) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML61057854) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2023-07-14 |