| NPI | 1629663646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 38077) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D84432) |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2021-03-02 |