| NPI | 1053846568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 076685) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101265792) |
| Enumeration Date | 2017-04-23 |
| Last Update Date | 2025-06-13 |