| NPI | 1710549472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022017591) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2019023996) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-08-05 |