| NPI | 1093951311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 52506) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 262716) |
| 208VP0000X (Licence: NC 2021-00338) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2026-08-07 |