| NPI | 1063775286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI DO01134) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID O-0865) |
| 208000000X Pediatrics (Licence: NE 6813) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2025-10-08 |