| NPI | 1912950684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-20931) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS KS0420931) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2022-03-31 |