| NPI | 1861066367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 202401845) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL83629) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-08-05 |