| NPI | 1033804174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4351051121) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD.MD.70096177) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-06-09 |