| NPI | 1538788591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD481660) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 67792) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2023-07-14 |