| NPI | 1992370639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MT222365) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT222365) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2024-05-23 |