| NPI | 1780386789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2023021917) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11491) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2023-06-26 |