| NPI | 1013413814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101278005) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10063723) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2025-08-12 |