| NPI | 1922630904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 101014) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 33832) |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2024-11-19 |