| NPI | 1467930891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME149151) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 14864-I) |
| Enumeration Date | 2018-07-28 |
| Last Update Date | 2021-07-02 |