| NPI | 1093829327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G53663) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD159916) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2026-09-18 |