| NPI | 1689627754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: KS 04-23560) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-23560) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-11-11 |