| NPI | 1093565012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 80238) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 34340) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2025-07-23 |