| NPI | 1659868966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA 05021422) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL training) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-01-23 |