| NPI | 1013658632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC CS2100012851) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0102964) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-06-26 |