| NPI | 1851739775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019024442) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY TP154) |
| 208000000X Pediatrics (Licence: KS 04-40230) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2019-07-02 |