| NPI | 1396431433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2026010506) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-12854) |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2026-08-02 |