| NPI | 1477117117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 82237-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101274752) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2023-07-11 |