| NPI | 1861061913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA R-12275) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61550260) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-05-24 |