| NPI | 1831726157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U5116) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10231) |
| 208000000X Pediatrics (Licence: MO 2020015489) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2023-06-29 |