| NPI | 1174100127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 100598-851) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 31649) |
| 208000000X Pediatrics (Licence: MN 72012) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-06-23 |