| NPI | 1891226635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2021011324) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 69959) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-08-02 |