| NPI | 1639870587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2024021154) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11856) |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2024-08-27 |