| NPI | 1891226635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2024-0603) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 69959) |
| 208000000X Pediatrics (Licence: MO 2021011324) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2024-07-01 |