| NPI | 1619599685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA R-11769) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR DO214595) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2023-03-21 |