| NPI | 1134869696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 82141) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2025-02382) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-05-12 |