| NPI | 1881191989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2021029502) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2018019012) |
| 208000000X Pediatrics (Licence: KS 04-45128) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2021-09-14 |