| NPI | 1841752573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 90404) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 91646) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2023-08-28 |