| NPI | 1811482458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY TP216) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-09650) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2021-07-13 |