| NPI | 1790675775 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 9412914) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2026026743) |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2026-06-26 |