| NPI | 1801380118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-15964) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301115761) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2025-08-27 |