| NPI | 1962964726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 78231) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 292606) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-12-30 |