| NPI | 1861851404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2023010012) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 30393) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2023-06-13 |