| NPI | 1093069411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C201309) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C10025067) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2025-07-01 |