| NPI | 1831757095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 66328) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-09898) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2022-07-28 |