| NPI | 1528555059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 54998) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 54998) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2024-08-19 |