| NPI | 1518530245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A192735) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI MDR-8086) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2024-08-21 |