| NPI | 1811647266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022023686) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11086) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-10-20 |