| NPI | 1174555130 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS007778L)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD H0090196)  | 
| 208000000X Pediatrics (Licence: RI DO00935)  | |
| Enumeration Date | 2006-07-07 | 
| Last Update Date | 2025-03-20 |