| NPI | 1811553597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301506639) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4351044275) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2023-08-02 |