| NPI | 1104453661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2023008506) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 76314-20) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-04-09 |