| NPI | 1811647266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.152688) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-11086) |
| 208000000X Pediatrics (Licence: MO 2022023686) | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-06-23 |