| NPI | 1598381873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022010844) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2020017709) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2023-03-08 |