| NPI | 1639798002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 2023-02042) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2023-02042) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2024-04-26 |