| NPI | 1801382700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019029592) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2018023897) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2021-04-09 |