| NPI | 1174101877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 344256) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101282056) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-08-07 |