| NPI | 1194179671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2019-00372) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 219029) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2025-10-03 |