| NPI | 1063498137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 200100133) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2001-00133) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2026-02-16 |