| NPI | 1619461167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101272562) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL52778) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2024-05-13 |