NPI | 1821654559 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 1023604) |
Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD478630) |
Enumeration Date | 2019-05-17 |
Last Update Date | 2025-06-16 |