| NPI | 1194732552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD26607) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD26607) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2026-04-02 |