| NPI | 1659689677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019019525) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 9409951) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2026-04-07 |