| NPI | 1639630486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 201902201) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10009) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2019-06-24 |