| NPI | 1164984670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 74925-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301509293) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-08-08 |