| NPI | 1114010725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 78448) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT MED-PHYS-LIC-91321) |
| 208000000X Pediatrics (Licence: CA A26103) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2026-03-17 |