| NPI | 1639741218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2024025972) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2024012598) |
| 208000000X Pediatrics (Licence: IA R-12283) | |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2024-07-01 |