| NPI | 1508421512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2022-01704) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL82175) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2022-07-21 |