| NPI | 1629668926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC MD91664) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 321088) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2024-06-07 |