| NPI | 1669996278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MN 65944) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MN 28625) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2019-07-23 |