| NPI | 1750876306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019032613) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2018018698) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2021-03-31 |