| NPI | 1629495965 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-40912) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML60470172) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2019-11-22 |