| NPI | 1841986759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2026005977) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-12904) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2026-08-20 |