| NPI | 1497319065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 67759) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 30258) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2020-08-26 |