| NPI | 1740740679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022013219) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10022) |
| 208000000X Pediatrics (Licence: MO 2019021230) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2022-05-09 |