| NPI | 1598114266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS18559) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116029428) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2022-06-07 |