| NPI | 1831991025 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2025018737) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-12379) |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-06-23 |