| NPI | 1811492887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME154164) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-44516) |
| 208000000X Pediatrics (Licence: MO 2021013825) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-04-13 |