| NPI | 1649703794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2020-0896) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML60756781) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2020-09-16 |