| NPI | 1508510694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022023891) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 9411100) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2022-08-03 |