| NPI | 1477058725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-44521) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2021013948) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2021-06-23 |