| NPI | 1033774716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022028780) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 13976-320) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-10-16 |