| NPI | 1720465438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019023001) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2018021687) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2022-09-17 |