| NPI | 1629699095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2023022059) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11570) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2026-07-07 |