| NPI | 1871029652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2020025522) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 70499-20) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-01-13 |