| NPI | 1861837171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A163667) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 9408056) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2021-12-20 |