| NPI | 1538663745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 39391) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-09700) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2022-09-21 |