| NPI | 1700526936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022020907) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11106) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-06-27 |