| NPI | 1114346608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101287124) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60871372) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2025-10-17 |