| NPI | 1831777044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2021021020) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10615) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2021-06-24 |