| NPI | 1649790635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 244249) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2017017610) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2021-08-07 |