| NPI | 1427552520 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-44946) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2018021670) |
| 208000000X Pediatrics (Licence: KS 94-09686) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2021-07-14 |