| NPI | 1912466871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2023014119) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 58.030661) |
| 208000000X Pediatrics (Licence: KS 94-11326) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2023-06-06 |