NPI | 1962909440 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: WI 85028) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 308900-01) |
Enumeration Date | 2018-04-10 |
Last Update Date | 2025-03-12 |