| NPI | 1154458867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 84652) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD037381) |
| 208000000X Pediatrics (Licence: WA OP60663438) | |
| 208000000X Pediatrics (Licence: MD H0067778) | |
| 208000000X Pediatrics (Licence: GA 063173) | |
| 208000000X Pediatrics (Licence: TX W0875) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2026-05-15 |