| NPI | 1689637977 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KS 04-31705) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AZ 57675) |
| Enumeration Date | 2006-04-09 |
| Last Update Date | 2024-12-09 |