| NPI | 1730766056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2021018953) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10513) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2021-06-25 |