| NPI | 1841723681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61440877) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AK 160483) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2023-08-02 |